Back to Work for the Breastfeeding Mom

Breastfeeding is finally becoming easier, you’re in a manageable routine, your baby is finally falling into a more predictable feeding pattern and now you have to prepare to go back to work. Sigh. The thought of leaving your baby can cause a lot stress, especially when it’s time to begin preparing for your absence. How and when do you start building a breastmilk stash for baby before you start working? How do you introduce a bottle to a breastfed baby? How do you determine how much milk your baby will need when you’re at work? What should your pump schedule look like when you’re away from your baby? How should you store your milk? Will your baby be willing to take a bottle while you’re gone and breastfeed when you’re together? These are some of the common key questions I hear from working moms and I’ll answer them for you!

How do you begin building a breast milk stash for your baby before you start working?

Believe it or not, you don’t need a huge stash of breast milk saved up before you start work. You really only need 1 days worth of milk saved for your first day back. When you’re at work, you will pump the milk you need for the next work day and so on. Friday’s pumped milk will become baby’s bottle feedings for Monday. If you nurse your baby right before you leave for work and immediately upon return, you will need to leave baby approximately 1-1.5 oz of breastmilk per hour you are separated. With this in mind, you can calculate how much milk you will need saved before that first day back to work. Start collecting milk a minimum of 2 weeks before you start back to work. You can collect milk by adding in pumping sessions after a few nursing sessions throughout the day, especially in the late evening or early morning when your prolactin is the highest. Some moms can collect the amount of milk they need just by using the Haakka on the opposite breast baby is feeding on. Don’t be discouraged if you’re only getting 1/2oz-2oz of milk per pumping session. This is normal! Keep pumping and collecting and eventually you can accumulate the milk you need for your first day back to work.

How do you introduce a bottle to a breastfed baby?

Ideally you’ve started introducing the bottle to your baby around 4-6 weeks old so it’s not completely foreign to them. If you haven’t, that’s ok, start introducing it now (or at least 2 weeks) before you return to work. Get a slow flow nipple for the bottle you’re using and start trying to feed your baby small amounts with the bottle about 1 hour after a nursing session. Always use the paced feeding method when offering the bottle. If you’re unsure what paced feeding is, check out my past blog or look up paced bottle feeding information from La Leche League or KellyMom.

How do you determine how much milk your baby will need when you’re at work?

Plan to nurse your baby right before you leave for work and as soon as you return from work. That way you won’t have to pump as soon as you get to work and right before you leave work. You will need to leave your baby approximately 1-1.5oz of breastmilk per hour of separation.

What should your pump schedule look like when you’re away from your baby?

Ideally Pumping should mimic your baby’s feeding pattern while you’re at work. Since this is not always an option, you can plan to pump at least every 3 hours for 15-20 minutes while you’re away from your baby. Talk to your boss ahead of time and secure a designated quiet place to pump to save time and added stress.

How should you store your milk?

Refrigerate your expressed milk as soon as possible if you don’t plan to feed it to your baby within 4 hours. If you don’t have a refrigerator at work, use ice packs in a cooler to keep the milk cold until you get home. Once you’re home, refrigerate milk you plan to use within 5 days and freeze milk if you plan to use it after 5 days.

Will your baby be willing to take a bottle while you’re gone and breastfeed when you’re together?

Every baby is different! Some babies will find it hard to toggle back and forth from bottle to breast and some transition perfectly. An important step to take to ensure baby comes back to the breast is to make sure your caregiver uses the paced feeding method when bottle feeding. Nurse your baby just before you leave for work and as soon as you arrive home. Plan for extra skin to skin time when you’re together and nurse whenever your baby wants. You might find baby wants to nurse more at night to make up for the time missed with you during the day. If your baby is having a hard time taking a bottle when you’re at work, check out my blog about bottle refusal.

Going back to work can cause a lot of stress for a breastfeeding mama. Keep in mind that you and your baby will eventually fall into a routine and the transitions from breast to bottle will become easier. If you’re having trouble with anything mentioned in this blog, please reach out to an LC! We can help you make a smooth transition from home to work with a care plan tailored just for you and your baby.

Pacifier for the Breastfed Baby?

There are a lot of opinions about pacifiers for breastfeeding babies and some experts will recommend limiting their use or not introducing them at all. Let’s look at the reasoning behind this recommendation. Pacifiers or ‘dummies’ as they call them in the UK are essentially an artificial nipple made for babies to ‘pacify’ them until their next feeding. When we use a pacifier for our breastfeeding baby, especially in the early weeks, we can miss important feeding cues that our baby uses to let us know they’re ready to nurse. Some of these cues are putting their hand to their mouth, sticking their tongue out, mouthing, etc. and are impossible for a baby to do while sucking on a pacifier. Pacifiers also decrease the amount of time our baby suckles at the breast which can sometimes lead to poor weight gain in baby and/or decreased milk supply for mom. When we allow our baby to nurse and/or suckle at the breast often in the early weeks, they are essentially establishing mothers milk supply. Pacifiers can really limit this special communication between the baby and the breast and because of this, babies who receive pacifiers are more likely to wean from the breast earlier than babies who don’t use one.

Pacifiers certainly do have their place and can be beneficial in certain situations, even for babies who are or will be breastfeeding. Pacifiers can help premature infants practice and strengthen their sucking reflex and can help tube fed babies associate sucking with food when given simultaneously. Pacifiers also may help reduce the risk of SIDS. Although, breastfeeding alone already decreases the risk of SIDS by more than 50% so this benefit is more for bottle fed babies. Pacifiers are great when used to soothe babies during medical procedures or even in less serious situations like riding in the car or passing the time while mom runs an errand.

As an LC, I’m often asked if and when a pacifier can be introduced to a baby. I typically ask moms to try and wait at least 4-6 weeks until their milk supply is established first. It’s also important that the baby’s weight gain has been sufficient before offering a pacifier. Make sure you are offering the breast first and only allowing the baby have the pacifier for short intervals such as on car rides, in a store, or in places when nursing isn’t possible. As a mom, you make the best decisions for you and your unique situation and if that includes using an occasional pacifier for your baby, then so be it! However, if you and your baby have been fine getting along without a pacifier so far, save yourself potential problems down the road and just don’t even offer one.

Breast Storage Capacity

There are a lot of factors that can influence the amount of times your baby needs to nurse in 24 hours. One of these factors is your breast storage capacity. If you have a large storage capacity, your baby may be able to consume 5+ ounces of milk per feeding, keeping them feeling full longer. If you have a small storage capacity, your baby might only consume 2 ounces or less per feeding and will need to nurse more frequently throughout the day and night to get the calories they need.

A small or large breast storage capacity depends on the maximum volume of the mothers grandular tissue. Not to be confused with fatty tissue of the breast which makes our breasts appear physically larger or smaller. A woman with large breasts may have smaller grandular tissue capacity than a woman with smaller breasts and vice versa.

The good news is, no matter what your grandular tissue storage capacity may be, most mothers have the ability to produce a full milk supply for their baby. If your breast storage capacity is small, your baby will want to nurse more often throughout the day and night to consume the amount of daily calories they need. If you have a large storage capacity, your baby may want to nurse less during the day or sleep long blocks at night because they are consuming larger amounts of milk per nursing session.

The benefit to having a smaller milk storage capacity is that your baby is more likely to empty your breasts at each feeding. This ensures that your baby is consuming the higher fat milk or hindmilk that is available when the breasts are on the empty side. The emptier the breast, the higher the milk fat content. The more full the breast is, the lower the milk fat content.

You might have already guessed the benefit to a higher breast milk storage capacity. Longer intervals between feedings and possibly longer stretches of sleep at night! However, some moms with a larger storage capacity can be more susceptible to clogged ducts, mastitis and their babies may experience more digestive discomfort especially in the early weeks.

It’s important to remember that whatever your breast storage capacity is, you likely have the ability to make enough milk for your baby. Small glass or large glass, which one does your body offer your baby?

When to seek the help of a Lactation Specialist

Are you wondering if you should seek the help of a lactation consultant? Every mothers’ breastfeeding journey is beautifully unique and may come with more challenges than you were expecting. I am trained to help you navigate through the issues that come up and find solutions that work for you and your baby. Here are a few common reasons a breastfeeding mother reaches out for lactation support.

-You get home from the hospital and your milk comes in. You want to make sure your baby is gaining well and emptying your breasts efficiently.

-Your milk came in late and/or your baby dropped a significant amount of weight after birth.

-Feeding is becoming difficult and your baby is fussy at the breast.

-Your baby feeds too little or too often and you want to know how much milk they are transferring in a nursing session.

-You’re experiencing nipple pain, soreness or damage.

-You have a fast letdown and you want to help baby manage the flow.

-Your baby spits up a lot and you want to know if there is something you can do to manage it.

-You have too much or to little milk and need your supply to match baby’s needs.

-You need advice on when and if you should pump. Do your flanges fit correctly?

-You’re unsure if you should be nursing, pumping, hand expressing, using the Haakka or all the above.

-You’re going back to work and you need a pump/nursing plan and advice.

-You feel as if you need a professional to evaluate and reassure you that things are going well with breastfeeding.

-You’re feeling overwhelmed and need a care plan for feeding, sleeping and taking time for yourself.

-You’re wondering if your baby might be allergic to something in your diet.

-Your baby is colicky and you’re wondering what you can do about it.

-Your baby has oral ties and you need breastfeeding support before or after a revision.

-You suffer from clogged ducts or mastitis.

-Your breasts are always sore and uncomfortable and you want to figure out the root of the problem.

-You want to wean or begin solids and you don’t know where to start.

You don’t need to try to work through breastfeeding issues on your own! I’m here to help. Contact me via PM, text, call or email. Feel free to join my breastfeeding support FB group to connect with other local bf mothers. We’re in this together! https://www.facebook.com/groups/442088640517440/?ref=share

For reviews, services and my affordable pricing, visit my FB @loveandlactation or website http://www.loveandlactationnc.com

My Top 10 Breastfeeding Support Supplements

Moms always ask me what supplements they should be taking while breastfeeding. If you are eating a well balanced diet and things are going well with breastfeeding, you don’t have to add additional supplements to your diet. However, there may be issues you’re experiencing that might justify adding certain supplements to your breastfeeding care plan.

Moms most often ask about supplements to increase their milk supply. Interestingly enough, only two of the supplements I commonly recommend are considered to be galactagogues (food/drinks thought to increase milk supply). For the most part, galactagogues aren’t successful for EVERY mom, they can be expensive and some are even thought to decrease milk supply. There is no supplement that works better than extra nursing/milk expression to increase milk supply.

When I recommend supplements, they are only in addition to the extensive care plan we’ve come up in our lactation session and they act as extra reinforcement. The 10 supplements I love best are thought to help with colic, digestive discomfort, clogged ducts, thrush, spit up, energy stores, etc.

If you’re interested in trying any of the top 10 breastfeeding supplements I mention below, you should definitely run it by your doctor first just to make sure it’s safe for you and/or your baby.

-Probiotics- For mom AND baby. I can’t stress how important gut health is for everyone, breastfeeding or not! Luckily, breast milk is a natural probiotic. However, if your baby experiences reflux, spit up, gas, colic, thrush, etc. you may want to add in an additional probiotic supplement for both of you to see if you notice an improvement in symptoms.

-Digestive Enzymes-For mom. DI’s breaks down the larger protein molecules in moms diet making it even easier for baby to break down. They can help with digestion, gas and can help calm fussiness.

-Sunflower Lecithin- For mom. Sunflower Lecithin is a fat emulsifier and it helps to prevent clogged ducts and mastitis. It’s much more successful when used as a preventative rather than a treatment.

-Calcium and Magnesium- For mom. Our bodies extract calcium from our bones when we breastfeed so it’s important to add extra calcium to our diet via food or supplement. Magnesium helps with calcium absorption and also helps mom recover from birth and sleep better at night. *It’s important to note that after weaning, our bodies recover from the calcium loss whether we supplement or not!

-Omega 3- For mom. Omegas-3 is great for better mood (may help mom release more oxytocin), circulation, and brain health.

-Vitamin D-For mom and baby. Vitamin D is not easily passed through breast milk. Mom should take 6,400 IU of it to make sure baby gets the recommended dose via her milk or supplement baby with 400 IU. Whether you’re supplementing or not, get outside and soak up some natural Vit D from the sun each day!

-Cumin & Fennel- For mom. These herbs are anti-inflammatory and can provide digestive support for mom and baby via her milk. They make cumin and fennel teas or you can add these yummy herbs to your food!

-Morniga- For mom. Morniga has been associated with an increased milk supply in mothers who consume it. This is the only galactagogue I like to recommend because even if it doesn’t increase a mamas milk supply, it can at least help boost her immune system, assist with sensitivity to allergies and provide an overall nutrient boost.

-Ginger- For mom. Ginger is an anti-inflammatory, anti nausea, immune booster and has been thought to increase milk supply. It also is great to use in place of coffee/caffeine in the morning for a boost of energy.

Breast Pumping Tips

Breast pumps are useful when you need to replace nursing sessions, maintain your milk supply and collect or save milk. They can also be used after nursing sessions to encourage your body to make more milk, beyond what your baby has removed from the breasts. How do you make sure your pumping sessions are efficient and effective at collecting the amount of milk you need for your baby? Try these tips to make the most of your pumping sessions.

-Plan ahead! Set up to pump in a quiet, comfortable, stress free environment.
-Make sure your pump parts are in good condition. Replace pump parts after 3 months of continuous use or even earlier if you notice the parts have tears, scratches or appear worn. Inspect the parts before each pump session.
-Make sure your pump flanges are comfortable and fit properly.
-If you cannot be with your baby while you pump, have a piece of your baby’s clothing handy with her scent, look at pictures of your baby and listen to videos of her noises. This will help your body release the oxytocin it needs to trigger a letdown. If your baby is near, you can help release the oxytocin by touching your baby, interacting and/or just adoring her!
-Close your eyes and visualize milk flowing abundantly from a waterfall, stream, faucet, etc. while you pump. It is also helpful to listen to sounds of streams, pouring rain or waterfalls. (This tip worked wonders for me!)
-Use hands on pumping. Massage your breasts before you pump and use breast compressions while you are pumping. Hands on pumping is easiest to do while wearing a comfortable fitting pump bra.
-Let gravity do its job by leaning forward every few minutes while using breast compressions to effectively drain the breasts. (Don’t lean too far forward or milk can drip out of the bottles!)
-Make sure you are using a comfortable setting on your pump. A higher suction does not mean you will get more milk. Pumping should be comfortable and not painful. Start at a low suction and work your way up until you find the setting that works best for you.
-Cover the collection bottles so you don’t watch the milk accumulating. It can be discouraging and affect your letdown if you stare at the bottles.
-Save your favorite snack or treat to enjoy during your pumping sessions.
-Find a comfortable pumping bra that fits properly and is not too tight. Buy 2 of the one you love so you have a backup.

Pumping can be a great tool to use when you must be away from your baby. If you are pumping to increase your milk supply, replace nursing sessions on a regular basis or pump exclusively, it is important that you use a double electric pump. If your baby is in the NICU and/or born prematurely, it is recommended to use a hospital grade pump until you and your baby reunite with regular skin to skin and nursing sessions. Pumping can take practice before you begin to see a typical milk output. Keep trying, use the tips mentioned above and eventually you and your body will begin to respond positively to the pump. And remember, a pump is not as effective as a nursing baby is at removing milk! Therefore, the amount of milk you pump is not a good indication of how much your baby removes from the breasts while nursing. Happy Pumping!

Montgomery Glands

Montgomery glands are the little tiny bumps around your areola that become more prominent during pregnancy and lactation. I’ll never forget a client of mine noticing hers early postpartum and asking me if she’s had a reaction to breastfeeding. I was happy to tell her all of the amazing things these little bumps are designed for!

Montgomery glands are a mothers very own sanitizing factory during lactation! They secrete an antibacterial oil that helps to keep mothers nipples free from harmful bacteria. They protect beneficial bacteria that can nurture a healthy gut for your baby when they nurse. Montgomery glands help lubricate mothers nipples to help protect them from dryness and cracking between nursing sessions.

The oils that the Montgomery glands secrete during lactation have a scent that attracts the baby to mothers nipples for milk. The scent makes it easier for your baby to find her food source. If you allow a newborn baby to lye on your chest, the scent from your Montgomery glands and the color of your areola’s will help lead your baby to the milk.

Montgomery glands keep mothers nipples clean and safe for baby without the need for extra washing or wiping before nursing or pumping sessions. Your daily shower is enough to keep that area clean for your nursling and allow the Montgomery glands to do their job secreting that natural scent for your baby. Other than your daily (or every other day) shower, let your magical Montgomery glands go to work for you keeping your nipples clean, healthy and ready for nursing!

Increasing the Fat in your Breastmilk

Many moms have asked me if there is a particular food they can eat to ‘fatten up’ their milk and help their baby gain weight. Interestingly, studies show that the foods a lactating mom consumes has little influence on the AMOUNT of fat in her breastmilk, but her diet can affect the TYPE of fat her breastmilk contains. Women in 3rd world countries with poor diets have breastmilk composition similar to mothers who don’t have nutrition concerns here in the US. Increasing your fat intake won’t increase the fat in your breastmilk. But you can alter the type of fat in your milk with the foods you eat. It’s important for breastfeeding mothers to consume healthy unsaturated fats such as avocado, coconut, nuts/seeds and olives. Saturated fats such as animal fats and processed foods can put mom at higher risk for clogged ducts or mastitis.

Breastmilk has about 3.5-4.5% fat content across all lactating mothers and the amount of fat varies between these percentages with each feeding. If a mother wants to increase the fat content in her milk, she needs to increase the number of times she’s feeding her baby per day. Frequent feedings allows for a higher fat concentration in moms milk. When a mother waits long intervals between breastfeeding, the milk in her breasts becomes ‘diluted’ and lower in fat. When mom feeds her baby more often (every 1.5-2.5 hours), the milk is richer and higher in fat.

Moms can also add higher fat content to their milk by hand massaging the breasts as they nurse or pump. This will help massage the fat into the milk before it is expressed.

Breastmilk is considered the perfect food. It is naturally created to fulfill the nutrients your baby needs and it changes accordingly throughout the months of your baby’s life. If your baby has trouble gaining weight and you want to make sure he gets the fat that he needs, feed him frequently and make sure to empty one breast completely before switching to the other. Always try to consume healthy unsaturated fats instead of the unhealthy saturated fats to keep mama healthy and baby’s breastmilk optimal. Massage the breasts while feeding to be sure your baby is getting all of the fatty milk stored in the breasts.

When to Pump and Dump

A few years back pumping and dumping was a recommendation given to mamas who consumed alcohol and/or prescriptions drugs that were incompatible with breastfeeding. The thought was by removing the milk, you would also remove the harmful substance. We now know that pumping and dumping does not necessarily remove alcohol and/or a potentially harmful substance from breastmilk. Instead, the substance metabolizes out of the milk the same way it does out of the blood, with time.

So why would we ever need to pump and dump? To preserve your milk supply! For example, if you plan to go out and have a few drinks , you would need 1.5 hours per drink for it to metabolize out if your milk safely enough to feed baby (with a max of 3 drinks). So say you have 2 drinks. It’s recommended to wait 3 hours before safely feeding baby. If you have an infant that nurses every 2-3 hours, you might want to pump within this 3 hour time frame to make sure you maintain your milk supply. In this case, you want to pump to keep your milk supply on track and dump the milk to be sure you don’t expose baby to the alcohol.

Pumping and dumping does not remove alcohol from your milk. But it can be used to preserve your milk supply while you’re enjoying drinks. In time, the alcohol will metabolize out of your milk and it will be safe for baby to nurse wether or not you pump and dump. Stick with the 1.5 hours time after each drink recommendation to stay on the safe side and not expose baby to alcohol. However, if you have 1-2 drinks and you feel sober enough to drive a car before the recommended time is up, it’s probably safe to breastfeed as well!

So what if you have an older baby and you don’t necessarily need to pump or nurse every 3 hours to protect your supply? Do you have to pump and dump? Nope! In time, the alcohol will metabolize out of your milk. There is no need to pump and dump if you’re not worried about a possible temporary dip in your milk supply.

Differences in Milk Output from One Breast to the Other

Many breastfeeding mothers notice a difference in their breasts in terms of size and milk output. You may also notice that baby favors one breast over the other even when they are kept in the same position and just moved to the opposite breast. This is normal! Think of your breasts as 2 different vessels. One may offer more milk than the other. One breast may letdown faster and stronger. Your baby is smart and will gravitate toward the breast that offers the flow rate and milk capacity they prefer.

When you pump you may notice a difference in output. This could be because of the anatomical differences in your breasts. It could also occur because your baby stimulates your milk production more so in one breast than the other. Typically, there is no need to even out the milk supply in your breasts. However, if you want to stimulate more production in the breast that produces less, here are some tips.

On the less producing breast:

-Start nursing sessions on this side

-When you pump, pump this breast a few minutes longer (or one letdown longer) than you do on the other one

-When you switch breasts, put the haakaa on the less producing breast to encourage it to produce more milk

-Hand express a little milk from this breast before latching baby so she gets an instant milk reward

-Use breast compressions on this breast while feeding baby to speed up the flow rate

It’s important to recognize if your baby is preferring a breast or a head/neck/body position. If you notice your baby is preferring a certain position and seems uncomfortable in the less favored position, a pediatric bodywork specialist or chiropractor can help.

I admit I do laugh when my clients refer to their lesser producing breast as the ‘slacker boob’. But I tell them if that breast is giving you any liquid gold whatsoever, it’s not a slacker! 💛